


Of Serena and Sepsis Six

by Cinnamon68



Category: Holby City
Genre: Angst, F/F, Femslash
Language: English
Status: In-Progress
Published: 2016-10-06
Updated: 2016-10-06
Packaged: 2018-08-19 22:46:16
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 1,295
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/8227331
Author URL: https://archiveofourown.org/users/Cinnamon68/pseuds/Cinnamon68
Summary: A patient rapidly deteriorates on AAU as Raf and the team worry about her and Serena moping in her office.





	

**Author's Note:**

> This was written as I was trying to write an academic essay for my Masters module on 'Recognising and dealing with, deterioration in critically ill patients, with particular regard to human factors' A bloody mouthful, I know. I dutifully sat down to write, but this appeared instead. It does demonstrate excellent use of SBAR, a tool used by many NHS organistaions, to hand over patients in a consistent way, and the use of the 'Sepsis Six' guidelines, developed to minimise morbidity and mortality from sepsis. More information here, https://en.wikipedia.org/wiki/Sepsis_Six, if you are interested. Please visit the Sepsis Trust website here, http://sepsistrust.org/ to learn about sepsis. It may come in handy one day. September was Sepsis Awareness Month, to try and educate everyone, professionals and general public, about this serious condition. The next Chapter will be all Serena/Bernie angst, and very little medical info! I have used a couple of my original characters first seen in my 'Back to Work' series.

Raf started the evening review of the patients on AAU, by himself. Normally he would be going round with Serena, but she had not left the office since Bernie's departure and he kept stealing glances at her. She still seemed upset and wasn't showing any inclination to move from sitting hunched over her desk. Raf was perplexed. He didn't know what to do for the best, so he just got on with the work; at least she wouldn't have to worry about that.

 

Lou was also wondering what had happened between Serena and Bernie. Serena had behaved extremely uncharacteristically. Lou had never seen her display so much emotion, especially in front of everyone. Her heart went out to Serena; Lou really was very fond of Serena, as were all the AAU staff. She wanted to help, but wasn't quite sure what to do. On her break, she went to Pulses to buy Serena's favourite coffee, and a pastry.  She took them in to Serena, put them down next to her, and squeezed Serena's shoulder.

 

Serena didn't look up. Lou retreated saying, “If there's anything we can do...” Lou wasn't. even sure Serena had heard her.

 

Lou looked over to Amy Jones, a 25 year old woman who had returned from theatre, following a nasty appendicectomy, yesterday. Lou would have been happier if she'd gone to HDU, but there were no beds. She was becoming increasingly worried about the young woman in the last few hours. She had allocated Alice, a new but extremely competent staff nurse to look after her. Alice called her over with a worried expression on her face.

 

“I'm really worried about her,” Alice began. “Her temperature is up to 39.6, and her BP has dropped a little. She's tachycardic at 110 and her oxygen sats fell to 89% in air, so I've given oxygen, and they are up to 95%, but that's on 15l and she's somewhat confused at times.” Alice showed Lou the observation chart.

 

“Can you put another line in, Alice?” Lou enquired. “I'll get Raf.”

 

Alice wheeled the cannulation trolley over, selecting a large gauge cannula, as Lou speeded up the Saline infusion, through the existing cannula. Alice expertly slid the cannula in, taking the necessary blood for testing, as Raf appeared at Amy's bedside.  Alice constantly reassured the worried Amy, who was drifting in and out of consciousness.

 

“Probable sepsis.” Lou said. “We've given high flow oxygen, inserted a large bore cannula, taken blood for  culture, fbc, urea and electrolytes, lft bone profile, and lactate.  We're on with a gas. We've speeded up the fluids. Do you want to change the antibiotics? She's on Cef and Met at the moment.”

 

Raf did a rapid assessment, agreeing with Lou, asked for IV tazocin, which Alice quickly drew up and gave. and asked Lou to ring the critical care outreach team. “Who's covering it today?” Raf asked.

 

“Ali Wylie, I saw her earlier.” Lou replied. “I'll give her a call. I think they'll have to find space.”

 

As Lou phoned Ali, Raf gave Amy a bolus of saline, and asked Alice to pass a urinary catheter. Lou returned, saying they were setting up in HDU, and Ali was coming down to see Amy.

 

“I think I'd better let Serena know.” Raf looked worried, not wanting to disturb his friend and boss.

 

“I'll do it.” Lou smiled at Raf. “I think the distraction will do her good. I hate to see her like this!”

 

Lou knocked on the consultants' office door, waiting for Serena to compose herself and say;

 

”Come in!”

 

“Ms Campbell, can you come and look at Amy Jones? Looks like sepsis.” Lou noticed the untouched coffee and pastry that she had brought in earlier, and sighed.

 

It was on the tip of Serena's tongue to say ' _Can't Raf handle it?',_ but then she thought _that's not fair, and_ _anyway_ _I need to do something_ _before I go mad_ _!_ _Get a grip, Campbell!_

 

“Yes, yes; of course. Serena said, rising from her chair and following Lou. She was trying to remember who Amy was. _The young woman who'd had the append_ _ic_ _ectomy_ _yesterday_ _?_

 

Reaching the bed, she noticed Raf look up.

 

“Thanks for taking a look. This is Amy Jones; rapid deterioration in the last hour. She's currently maintaining her airway, rousable at times.  GCS 11, (E=3, V=3, M=5) Hyper-pyrexial, tachycardic, tachypnoeic, hypotensive, and dropping oxygen saturations to 89%.   Amy is a previously healthy 25 year old female, admitted with abdominal pain, vomiting and pyrexia 2 days ago. She underwent laparoscopic appendicectomy yesterday and was transferred here from Keller, as they had no bed. She was receiving IV fluids, and IV Cef and Met prior to the deterioration.” Raf handed Serena the iPad with Amy's pre-operative MRI on it. “She's had a second large gauge cannula inserted, blood obtained, IV tazocin, and bolus of saline. She has high flow oxygen in situ, maintaining saturations around 94%. A urinary catheter has been fitted, and is draining.” Raf looked at the measure, pleased to see at least 100ml of clear urine. “We've contacted the critical care outreach service, and are currently awaiting a bed. I recommend she's transferred there for further observation and management.”

 

Whilst Raf had been giving his report ( _excellent demonstration of SBAR*_ , Serena thought. _Which courses has he been doing recently?_ ), Serena had made a rapid assessment of Amy. She was in no doubt that Raf had been spot on. Maureen, one of the HCAs returned with the blood results and handed them to Serena.

 

Serena perused them, her eyebrows rising “OK. WCC 24, crp 272, and lactate 6.7, as well as metabolic acidosis. Looks like we're definitely dealing with sepsis. Well caught, everyone. She'll need a repeat MRI and then possible drainage of the collection, soon, but let's get her stabilised in HDU first.” Serena looked round at Lou and Alice just as Ali Wylie arrived, with a colleague, to inform them, the bed in HDU was ready. “Looks like I'm surplus to requirements.” Serena  retreated back to her office.

 

“No need to worry, the cavalry is here.” Ali intoned, laughing. After Raf handed over, again.  Ali arranged a porter to take Amy up to HDU with her colleague, and collared Lou. “What's gotten into Ms Campbell?” she asked, eyeing the consultants' office.

 

Lou sighed. “Something to do with Bernie taking the secondment in the Ukraine.” Lou explained. The secondment had been the talk of the hospital, all day. “She seemed really upset when Bernie left. I'm not sure what's going on with the pair of them?”

 

Lou explained the encounter that had taken place on AAU just a few hours earlier and as she knew Jenny and Bernie had struck up a friendship, bonding over years of army life, she hoped Ali would have a better handle on what was going on.

 

“Wow, I've never heard of Serena displaying such emotion, so openly before.” Ali said, giving nothing away. “Well I'd better get back. See that my Unit is still functioning. Call me when you need rescuing again!”

 

“Yeah, right!” Lou moaned. “Same old, same old. We do all the work, and you get all the glory! Seriously, will you ask Jenny to check in with Bernie? They need to sort this out!” _Not least because I can't cope with a moping Serena for however long Bernie is away,_ she thought, and also because she felt everyone deserved a little happiness. Lou was a romantic at heart. Despite her relationship with Jimmy, a radiographer, recently ending, she still hoped to find Mr Right, one day.

 

“Sure thing,” Ali replied. _The path of true love never does run smooth!_ _s_ he thought, as she returned to the Critical Care Unit.

 

 

 

 

 

 

 

 

 


End file.
